October 22, 2019

Calls for Abstracts
Grants & Awards
Events & Training Opportunities


Article about Dr. Jennifer Baumbusch
Embracing the therapeutic relationship: The joy of seniors’ care

“A lot of people don’t like geriatrics because it’s not fast-paced,” Baumbusch says. “People avoid getting into therapeutic relationships with older people. I was different; that was the part I really embraced.”

Calls for Abstracts

International Forum On Quality & Safety In Healthcare

28-30 April Copenhagen, Denmark
DEADLINE 5 November
Are you interested in sharing your work in improving quality, value and safety of care at one of the largest conferences focused on healthcare quality improvement and patient safety in the world?

Our poster displays are a valuable opportunity to tell over 3,000 colleagues and experts from 70+ countries about your improvement and safety projects and to help others learn from your strategies and experience.

We encourage you to share your achievements and contribute with your work and ideas to improving healthcare worldwide.

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Grants & Awards

Alzheimer Society Research Program

DEADLINE: 8 November at 11:59 pm EST
The Alzheimer Society Research Program is looking for big, bold, out-of-the-box ideas to find the causes of dementia and breakthrough solutions in care. We are investing more in new investigators to spark their ideas and build their careers. We are looking for candidates across all disciplines who want to tackle the biggest challenge of our time.
Grants available:
-Proof of concept: $100,000 up to 5 years. Supports investigators with innovative, high-risk, high-yield approaches to research.
-New investigator operating grant: $200,000 up to 4 years.
-Post-Doctoral Fellowship: $100,00 over 2 years.
-Doctoral award: $66,000 over 3 years


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Health Care Administration and Organization
Health Care Innovation and Quality Assurance
Research Practice and Methodology

Health Care Administration and Organization

Nursing assistants’ perceptions of their role in the resident experience.
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K. Abrahamson, R. Fox, A. Roundtree and K. Farris.
Nurs Health Sci 2019 Oct 16
The aim of this study was to examine nursing assistants’ perspectives of their role in the nursing home resident experience. Recent efforts to improve nursing home quality are focused on providing person-centered care and improving the resident experience. However, the literature on nursing home quality lacks the perspective and experiences of nursing assistants themselves, despite their crucial role in the resident experience. Semistructured interviews were conducted with 25 nursing assistants from 17 organizations and seven states. Data were analyzed using an interpretive approach that identified relevant codes and themes. Respondents perceived that they play a pivotal role in the resident experience by providing choices, communicating important information, comforting, and living within the daily reality of cognitively impaired residents. Nursing assistants’ challenges included using non-verbal communication, balancing personal care while maintaining boundaries, and dealing with a perceived lack of trust. Nursing assistants are integral to interpersonal engagement with residents and relationship-based activities, such as communication, caring, and protecting. Increased nursing assistant input into programs and policies to improve the resident experience is warranted. Quality assessment should incorporate direct input from residents and nursing assistants regarding person-centered care.

Self-reported National Healthcare Safety Network knowledge and enrollment: A national survey of nursing homes.
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C. J. Fu, M. Agarwal, A. W. Dick, et al.
Am J Infect Control 2019 Oct 9
Predictors of nursing home staff knowledge of the National Healthcare Safety Network (NHSN) and facility enrollment were explored in a national survey. Facility participation in Quality Innovation Network-Quality Improvement Organization initiatives was positively associated with both knowledge and enrollment. In addition, engaging clinical personnel in decision making on NHSN enrollment was positively associated with staff knowledge of NHSN.

Certified nursing assistants as agents of creative caregiving in long-term care.
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J. Eaton, K. Cloyes, B. Paulsen, C. Madden and L. Ellington.
Int J Older People Nurs 2019 Oct 7:e12280
Certified nursing assistants (CNAs) provide most of the direct care for long-term care (LTC) residents, yet there are few CNA-led interventions aimed at improving quality of care. In our preliminary work developing a CNA art-based intervention, we describe CNA definitions and perceptions of creativity in relation to care of LTC residents. METHODS: Data from six sequential focus groups with CNAs (n = 14) in two LTC facilities were analysed to describe the concept of creativity in relation to LTC caregiving and its meaning to CNAs working in LTC. RESULTS: Certified nursing assistants defined creativity as formal art-making, yet they also described creative approaches to engaging residents in order to build relationships and reduce challenging behaviour. While most linked creativity with discerning and responding to resident needs, creativity was also foundational to time management, teamwork and navigating challenges. CONCLUSION: Developing CNA-centred interventions to promote creative caregiving may enhance both person-centred LTC and CNA empowerment, improving resident care. IMPLICATIONS FOR PRACTICE: CNA creativity should be viewed as a skill with the potential to enhance care and increase CNA empowerment. Interventions should be developed, in partnership with CNAs, to promote creative caregiving.

Care Personnel’s Attitudes and Fears Toward Care Robots in Elderly Care: A Comparison of Data from the Care Personnel in Finland and Japan.
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K. Coco, M. Kangasniemi and T. Rantanen.
J Nurs Scholarsh 2018 Nov;50(6):634-644
The aim of the study was to analyze and compare elderly care personnel attitudes toward care robots in Finland and Japan. DESIGN: Cross-sectional survey in Finland and Japan. METHODS: The Finnish sample was collected from care personnel in home care facilities in five municipalities in 2016. The Japanese sample was collected from personnel in two rehabilitative day centers and three residential care homes for the elderly in the north of Honshu Island in 2017. The data were analyzed using basic statistical methods and calculated descriptive statistics (frequencies). Differences between the Finnish and Japanese data have been analyzed using the Mann-Whitney U test. FINDINGS: Overall, Japanese care personnel assessed the usefulness of robots more positively than did their Finnish counterparts. The data showed substantial national differences in the perceived importance of various potential tasks for care robots. The findings show that there are also certain fears related to the introduction of care robots, in particular among the Finnish care personnel. DISCUSSION: The data from the Japanese care personnel bring new perspectives to the concept of a close human-robot relationship. The differences seen in the results between Finland and Japan can be partly explained by cultural dissimilarity, but it is also known that Japan is a more developed country with regard to the use of robotics in nursing care. The research highlights the importance of cultural factors when examining the issue of care robotics. The factors affecting fear are a concern that care robots would be used to replace people, the dehumanization of treatment, and an increased loneliness in the elderly. Thus, further research is required to demonstrate the relationship between different cultural factors, and attitudes and conceptions toward care robots. CLINICAL RELEVANCE: Management plays a key role when implementing robotics. It is important to help care personnel accept care robots, and to diminish any fears that their introduction would make the treatment of elderly people inhumane or in some way add to their loneliness. As such, education is crucial in changing attitudes and making care personnel understand that care robots can perform routine tasks, allowing care personnel to focus on providing improved care and nursing.

An evaluation of a safety improvement intervention in care homes in England: a participatory qualitative study.
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M. Marshall, N. Pfeifer, D. de Silva, et al.
J R Soc Med 2018 Nov;111(11):414-421
A growing proportion of older people live in care homes and are at high risk of preventable harm. This study describes a participatory qualitative evaluation of a complex safety improvement intervention, comprising training, performance measurement and culture-change elements, on the safety of care provided for residents. DESIGN: A participatory qualitative study. SETTING: Ninety care homes in one geographical locality in southern England. PARTICIPANTS: A purposeful sample of care home managers, front-line staff, residents, quality improvement facilitators and trainers, local government and health service commissioners, and an embedded researcher. MAIN OUTCOME MEASURES: Changes in care home culture and work processes, assessed using documentary analysis, interviews, observations and surveys and analysed using a framework-based thematic approach. RESULTS: Participation in the programme appears to have led to changes in the value that staff place on resident safety and to changes in their working practices, in particular in relation to their desire to proactively manage resident risk and their willingness to use data to examine established practice. The results suggest that there is a high level of commitment among care home staff to address the problem of preventable harm. Mobilisation of this commitment appears to benefit from external facilitation and the introduction of new methods and tools. CONCLUSIONS: An evidence-based approach to reducing preventable harm in care homes, comprising an intervention with both technical and social components, can lead to changes in staff priorities and practices which have the potential to improve outcomes for people who live in care homes.

Certified nursing assistants’ perspectives of the CARES® activities of daily living dementia care program.
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D. Dobbs, J. Hobday, R. Roker, M. J. Kaas and V. Molinari.
Appl Nurs Res 2018 Feb;39:244-248
There has been a proliferation of online training programs for nursing home direct care staff related to dementia care, yet little is known about the effectiveness of the training. Some evidence exists that online training is effective in addressing problem behaviors of nursing home residents with dementia by enhancing self-efficacy, improving attitudes, and increasing knowledge of nursing home staff. STUDY AIM: The current study aim was to evaluate the implementation of an online training program consisting of ten, one-hour modules which applies the CARES(R) concepts and learning framework to activities of daily living (ADL) care for persons with dementia. METHODS: Responses from Likert-type items, and open-ended questions were analyzed in a sample of 48 certified nursing assistants (CNAs) from 10 nursing homes in six states (ME, MT, ND, WI, MN, MO) that were part of a National Institute of Aging funded intervention study (Grant #AG026210). RESULTS: The mixed-method study findings indicated that CNAs gained a better understanding, more knowledge, and more confidence in caring for persons with dementia. Recommendations were made regarding training length and technical issues, and some questioned the practicality of providing person-centered care when resident assignment was very high. CNAs expressed satisfaction with the online training, found it easy to use, and many said they would recommend the training. CARES(R) ADL Dementia Care online training appears to be a viable way of helping CNAs address the personal care needs of long-term care residents. Future CARES(R) ADL Dementia Care program research should include more racially diverse CNAs.

Understanding Omissions of Care in Nursing Homes

AHRQ, 2019
Adverse events and poor health outcomes are continuing challenges for nursing home residents and staff. Research has shown that many resident harms are avoidable and may be caused by situations in which residents do not receive needed care, often called omissions of care. Omissions of care research in nursing home settings is limited and definitions of omissions of care vary. Therefore, AHRQ has developed a definition of omissions of care for nursing homes intended to be meaningful to stakeholders, including residents and caregivers, and actionable for research or improving quality of care. We developed the definition through a literature review and feedback from subject matter experts and stakeholders. To develop and describe the definition, project staff produced an environmental scan and final report, including resources to help nursing homes operationalize and apply the definition of omissions of care.

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Health Care Innovation and Quality Assurance

A systematic review of interventions for loneliness among older adults living in long-term care facilities.
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N. G. Quan, M. C. Lohman, N. V. Resciniti and D. B. Friedman.
Aging Ment Health 2019 Oct 11:1-11
This study aimed to review loneliness interventions for older adults living in long-term care (LTC) facilities over the past 10 years, to categorize interventions by type, and to compare effectiveness of loneliness interventions in these settings. Methods: Systematic review followed PRISMA guidelines. Articles matching search criteria were collected from PubMed, PsycINFO, and Web of Science from 2009 to 2019. The inclusion criteria were as follows: 1) English language, 2) intervention studies with a quantitative measure that compares pre-trial to post-trial changes, 3) loneliness as a primary or secondary outcome 4) subjects age >65, and 5) subjects living in a LTC facility, such as a nursing home, assisted-living, or hospice. Results: A total of 15 intervention studies qualified for systematic review. Most of these interventions were psychological therapies and leisure/skill development interventions. Approximately, 87% of studies reported significant decreases in loneliness following intervention. Laughter therapy, horticultural therapy, and reminiscence therapy were associated with the greatest decreases in loneliness. Discussion: Results suggest that, although less common than interventions in the community, there are several effective interventions to reduce loneliness among older adults living in LTC facilities. Lack of standardized measures and high-quality studies limits comparisons between intervention types and generalizability to different populations.

Consumer Response to Composite Ratings of Nursing Home Quality.
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M. C. Perraillon, R. T. Konetzka, D. He and R. M. Werner.
Am J Health Econ 2019 Spring;5(2):165-190
Health care report cards are intended to address information asymmetries and enable consumers to choose providers of better quality. However, the form of the information may matter to consumers. Nursing Home Compare, a website that publishes report cards for nursing homes, went from publishing a large set of indicators to a composite rating in which nursing homes are assigned one to five stars. We evaluate whether the simplified ratings motivated consumers to choose better-rated nursing homes. We use a regression discontinuity design to estimate changes in new admissions six months after the publication of the ratings. Our main results show that nursing homes that obtained an additional star gained more admissions, with heterogeneous effects depending on baseline number of stars. We conclude that the form of quality reporting matters to consumers, and that the increased use of composite ratings is likely to increase consumer response.

Engaging food service providers to change food service practices in aged care facilities.
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L. Matwiejczyk, R. Roberts, O. Farrer, et al.
Nutr Diet 2018 Sep;75(4):381-389
The present study describes the impact of a novel education program for food service staff from Australian aged care facilities (ACF) to facilitate improvements in food service practices. The purpose was to explore; (i) the impact of the intervention (ii) barriers and facilitators of the program from food service providers’ perspectives and (iii) make program planning and practice recommendations. METHODS: Participants completed pre- and post-program questionnaires, attended two focus groups on program process and impact and 4 months later reported through individual interviews on changes they had implemented. Results were triangulated between the questionnaires, focus groups and interviews and impacts and outcomes identified through directed content analysis. RESULTS: Thirty senior-level chefs and a cook participated from 27 ACF from Victoria, Australia. Participation impacted on the menu, dining experiences and food service practices. All of the participants were enacting changes in their workplace 4 months later as change agents. A focus on skilling the participants as ‘change agents’, brokering ongoing peer-support and the celebrity and/or expert status of the facilitators were attributed to the success of the intervention. CONCLUSIONS: This novel intervention empowered Victorian food service providers to make positive changes in ACF. Further research is required to measure if these self-reported changes are sustainable and relevant to other facilities and to establish the effect on food experience, satisfaction and well-being of residents.

Application of the European quality indicators for psychosocial dementia care in long-term care facilities in the Asia-Pacific region: a pilot study.
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Y. H. Jeon, W. T. Chien, J. Y. Ha, et al.
Aging Ment Health 2018 Oct;22(10):1279-1286
An Asia-Pacific regional collaboration group conducted its first multi-country research project to determine whether or not European quality indicators (QIs) for psychosocial care in dementia could be implemented as a valid tool in residential aged care across seven Asia-Pacific sites (Australia, Hong Kong Special Administrative Region, Mainland China, Malaysia, Singapore, South Korea, and Thailand). METHOD: Following the European QI protocol, auditing and data extraction of medical records of consenting residents with dementia were conducted by trained auditors with relevant health care backgrounds. Detailed field notes by the auditors were also obtained to describe the characteristics of the participating care facilities, as well as key issues and challenges encountered, for each of the 12 QIs. RESULTS: Sixteen residential care facilities in the seven Asia-Pacific sites participated in this study. Data from 275 residents’ records revealed each of the 12 Qis’ endorsement varied widely within and between the study sites (0%-100%). Quality of the medical records, family and cultural differences, definitions and scoring of certain indicators, and time-consuming nature of the QI administration were main concerns for implementation. CONCLUSION: Several items in the European QIs in the current format were deemed problematic when used to measure the quality of psychosocial care in the residential aged care settings in participating Asia-Pacific countries. We propose refinements of the European QIs for the Asian-Pacific context, taking into account multiple factors identified in this study. Our findings provide crucial insights for future research and implementation of psychosocial dementia care QIs in this region.

National quality improvement programmes need time and resources to have an impact.
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R. Cook, T. Lamont, R. Martin and NIHR Dissemination Centre.
BMJ 2019 Oct 9;367:l5462
A large trial assessing the effectiveness of a UK-wide quality improvement programme did not show any difference in patient outcomes. However, the likely reasons for this were carefully investigated and provide some useful insights on implementation.

Several (37) quality improvement components were included in the ambitious package designed to reduce variation in care and improve outcomes for adults undergoing emergency abdominal surgery. There was no difference in survival at 30 days, length of hospital stay or rates of re-admission between the usual care and intervention groups.

This NIHR-funded study included a process evaluation showing that the intervention wasn’t fully implemented in all the 93 participating hospitals. There was good engagement from clinical staff with the programme, but busy staff had limited time and resources to implement change.

To be successful, more attention needs to be paid to the practicalities and time required to implement such programmes.

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Research Practice and Methodology

Gender differences in grant and personnel award funding rates at the Canadian Institutes of Health Research based on research content area: A retrospective analysis.
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K. E. A. Burns, S. E. Straus, K. Liu, L. Rizvi and G. Guyatt.
PLoS Med 2019 Oct 15;16(10):e1002935
Although women at all career stages are more likely to leave academia than men, early-career women are a particularly high-risk group. Research supports that women are less likely than men to receive research funding; however, whether funding success rates vary based on research content is unknown. We addressed gender differences in funding success rates for applications directed to one or more of 13 institutes, representing research communities, over a 15-year period. METHODS AND FINDINGS: We retrospectively reviewed 55,700 grant and 4,087 personnel award applications submitted to the Canadian Institutes of Health Research. We analyzed application success rates according to gender and the primary institute selected by applicants, pooled gender differences in success rates using random effects models, and fitted Poisson regression models to assess the effects of gender, time, and institute. We noted variable success rates among grant applications directed to selected institutes and declining success rates over time. Women submitted 31.1% and 44.7% of grant and personnel award applications, respectively. In the pooled estimate, women had significantly lower grant success (risk ratio [RR] 0.89, 95% confidence interval [CI] 0.84-0.94; p < 0.001; absolute difference 3.2%) compared with men, with substantial heterogeneity (I2 = 58%). Compared with men, women who directed grants to the Institutes of Cancer Research (RR 0.86, 95% CI 0.78-0.96), Circulatory and Respiratory Health (RR 0.74, 95% CI 0.66-0.84), Health Services and Policy Research (RR 0.78, 95% CI 0.68-0.90), and Musculoskeletal Health and Arthritis (RR 0.80, 95% CI 0.69-0.93) were significantly less likely to be funded, and those who directed grants to the Institute of Aboriginal People’s Health (RR 1.67, 95% CI 1.0-2.7) were more likely to be funded. Overall, women also had significantly lower personnel award success (RR 0.75, 95% CI 0.65-0.86; p < 0.001; absolute difference 6.6%). Regression modelling identified that the effect of gender on grant success rates differed by institute and not time. Study limitations include use of institutes as a surrogate identifier, variability in designation of primary institute, and lack of access to metrics reflecting applicants, coapplicants, peer reviewers, and the peer-review process. CONCLUSIONS: Gender disparity existed overall in grant and personnel award success rates, especially for grants directed to selected research communities. Funding agencies should monitor for gender differences in grant success rates overall and by research content.

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Sepsis in Older Adults in Long-Term Care Facilities: Challenges in Diagnosis and Management.
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T. T. Yoshikawa, B. J. Reyes and J. G. Ouslander.
J Am Geriatr Soc 2019 Oct 16
Despite the current understanding of the pathophysiology of sepsis and advances in its treatment, the rate of sepsis is increasing globally. Sepsis is a common cause of hospitalization in older adults, and infections are among the most common diagnoses among residents transferred to the hospital from long-term care facilities (LTCFs). LTCFs and hospitals are facing financial and regulatory requirements to reduce potentially preventable emergency department visits, hospitalizations, and hospital readmissions due to infections and other causes. In addition, the human and financial costs of these events are substantial. Current criteria for early identification of sepsis have low sensitivity and specificity among LTCF residents. Early diagnosis must focus on changes in clinical, mental, and functional status, and vital signs including pulse oximetry. Laboratory data can increase the suspicion of sepsis, but the availability of testing and timing of results limits its usefulness in most LTCFs.While new diagnostic criteria for sepsis are being developed and validated in the LTCF setting, clinical practice and decision support tools are available to guide management. Most LTFCs do not have the capabilities to manage sepsis based on current guidelines despite availability of qualified nursing staff and clinicians. Thus excluding circumstances in which a resident’s desire is palliative or hospice care without transfer to a hospital, most LTCFs will continue to transfer residents with severe infections at risk for evolving into sepsis to an acute hospital setting.

Trends and Factors Associated with Place of Death for Individuals with Dementia in the United States.
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S. H. Cross, B. G. Kaufman, D. H. Taylor Jr, A. H. Kamal and H. J. Warraich.
J Am Geriatr Soc 2019 Oct 14
To assess trends and factors associated with place of death among individuals with Alzheimer’s disease-related dementias (ADRD). DESIGN: Cross-sectional analysis. SETTING: Centers for Disease Control and Prevention Wide-ranging OnLine Data for Epidemiologic Research, 2003-2017. PARTICIPANTS: Natural deaths occurring between 2003 and 2017 for which ADRD was determined to be the underlying cause. MEASUREMENTS: Place of death was categorized as hospital, home, nursing facility, hospice facility, and other. Aggregate data included age, race, Hispanic ethnicity, sex, urbanization, and census division. Individual-level predictors included age, race, Hispanic ethnicity, sex, marital status, and education. RESULTS: From 2003 to 2017, nursing facility and hospital deaths declined from 65.7% and 12.7% to 55.0% and 8.0% while home and hospice facility deaths increased from 13.6% and .2% to 21.9% and 6.2%, respectively. Odds of hospital and hospice facility deaths declined with age while odds of nursing facility deaths increased with age. Male sex was associated with higher odds of hospital or hospice facility death and lower odds of home or nursing facility death. Nonwhite race, Hispanic ethnicity, and being married were associated with increased odds of hospital or home death and reduced odds of nursing facility death. More education was associated with higher odds of home or in a hospice facility death and reduced odds of death in a nursing facility or hospital. Significant disparities in place of death by urban-rural status were also noted. CONCLUSION: As ADRD deaths at home increase, the need for caregiver support and home-based palliative care may become more critical. Further research should examine the care preferences and experiences of ADRD patients and caregivers, the financial impact of home death on families and insurers, and explore factors that may contribute to differences in actual and preferred place of death.

Music Therapy: A Novel Student Pharmacy Outreach to Manage Symptoms of Alzheimer’s Dementia.
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K. Nagy, M. Hill, K. R. Kroustos and K. F. Sobota.
Sr Care Pharm 2019 Oct 1;34(9):600-603
Patients with Alzheimer’s dementia (AD) often present with behavioral and psychological symptoms of dementia (BPSD), which may include anxiety, depression, and agitation, leading to a decrease in quality of life. Nonpharmacologic methods are recommended as first-line therapy for reducing BPSD. The student chapter of ASCP at Ohio Northern University Raabe College of Pharmacy has partnered with a local nursing facility to implement an active group music therapy (MT) outreach program to assist in management of BPSD. The program also evaluated the perceived effects of this outreach on students. In addition to having a profound impact on the residents, this outreach has also provided an excellent educational outlet for students to establish and practice skills in working with the AD patient population. In this article, we share our experiences with MT and provide education on how to implement MT outreach at your own institution or practice.

The Interaction Effect of Gender and Residential Environment, Individual Resources, and Needs Satisfaction on Quality of Life Among Older Adults in the United Kingdom.
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B. C. Liu, D. S. Leung and J. Warrener.
Gerontol Geriatr Med 2019 Sep 24;5:2333721419878579-Dec
To examine the difference in gender and its impact on selected quality-of-life (QoL) domains of Social Production Function theory among older adults in England. Method: Based on an annual national adult social care service user survey conducted in the United Kingdom in 2016. QoL was assessed by a single-item construct, and independent variables were home design, access to information and local area, self-rated health, perceived pain/discomfort, perceived anxiety/depression, activities of daily living, use and satisfaction of formal and informal care, and demographic variables. Results: A total of 28,955 respondents aged 65+ years were interviewed. Multinomial logistic regression analysis found four interaction effects for predicting a very good/good QoL: (a) Female receiving non-co-residing informal care (odds ratio [OR] = 1.501, p < .01), (b) female feeling safe (OR = 1.499, p < .01), (c) female feeling satisfied with social contact with people (OR = 1.465, p < .05), and (d) female being helped in the use of time (OR = 1.370, p < .05). Conclusion: Findings suggest gender differences in QoL as men and women are heterogeneous with different health and disease patterns, health-/help-seeking behaviors, roles and responsibilities, and levels of resilience, needs, risks, and access and control resources. Practitioners should adopt a gender-specific assessment and personalized interventions to promote gender equality, empowerment, and long-term sustainable development for an aging society.

The impact of environmental factors on persons with dementia attending recreational groups.
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J. Cohen-Mansfield.
Int J Geriatr Psychiatry 2019 Oct 8
The Comprehensive Process Model of Group Engagement posits that personal factors (e.g., cognitive function), stimulus factors (e.g., group activity content, group size) and environmental factors (e.g., light, noise) impact the response to group activities. This paper reports the impact of environmental and group characteristics on engagement, mood, and sleepiness of persons with dementia attending group activities. METHODS/DESIGN: The sample included 69 nursing home residents. Environmental contexts of activities included time of day, location, noise, light and temperature. Outcome variables captured engagement, mood, and sleepiness, observed during 20 group activity sessions. Mixed model analyses were used to examine the impact of environmental and group attributes on the outcome variables. RESULTS: Background noise and time of day significantly affected outcome variables after controlling for participants’ cognitive functioning and group topic. Background noise was related with decreased engagement and increased sleepiness. Activities conducted before noon were associated with increased sleepiness. Group size did not affect the outcome variables. There was little variation concerning temperature and light. CONCLUSIONS: These findings have implications for architectural and ongoing planning. The methodology presents a model for continuous quality improvement. The main components of the Comprehensive Process Model of Group Engagement significantly impacted group activity engagement.

Comparison between multicomponent and simultaneous dual-task exercise interventions in long-term nursing home residents: the Ageing-ONDUAL-TASK randomized controlled study.
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C. Rezola-Pardo, H. Arrieta, S. M. Gil, et al.
Age Ageing 2019 Oct 9
BACKGROUND: the potential benefits of dual-task interventions on older adults living in long-term nursing homes (LTNHs) from a multidimensional perspective are unknown. We sought to determine whether the addition of simultaneous cognitive training to a multicomponent exercise program offers further benefits to dual-task, physical and cognitive performance, psycho-affective status, quality of life and frailty in LTNH residents. Design: a single-blind randomized controlled trial. SETTING: nine LTNHs in Gipuzkoa, Spain. SUBJECTS: 85 men and women (ACTRN12618000536268). METHODS: participants were randomly assigned to a multicomponent or dual-task training group. The multicomponent group performed two sessions per week of individualized and progressive strength and balance exercises for 3 months. The dual-task group performed simultaneous cognitive tasks to the same tasks as in the multicomponent group. Gait speed under single- and dual-task conditions, physical and cognitive performance, psycho-affective status, quality of life and frailty were measured at baseline and after 3 months of intervention. RESULTS: both groups showed clinically significant improvements on gait performance under single- and dual-task conditions and on the short physical performance battery (P 0.05). Only the multicomponent group significantly improved quality of life, and reduced anxiety and Fried frailty score (P < 0.05). No group-by-time interactions were found except for the chair-stand test in favour of the multicomponent group (P < 0.05). CONCLUSIONS: the addition of simultaneous cognitive training does not seem to offer significantly greater benefits to the evaluated multicomponent exercise program in older adults living in LTNHs.

Social Support and Patterns of Institutionalization Among Older Adults: A Longitudinal Study.
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A. Oh, K. Patel, W. J. Boscardin, et al.
J Am Geriatr Soc 2019 Oct 8
To identify participants living at home and to estimate the risk of their transition into an institutional setting. DESIGN: Prospective cohort study from the National Health and Aging Trends Study (NHATS), a nationally representative survey of US adults aged 65 and older. SETTING: US national sample. PARTICIPANTS: A total of 4712 NHATS participants were living at home in 2011. Residential transitions were described every year through 2017. MEASUREMENTS: The primary outcome was transition time into an institutional setting. Primary predictors were social support factors (living spouse, lives with others, presence of social network, and participation in social activities). Covariates included age, sex, race, cognitive status, functional disability, multimorbidity, and Medicaid enrollment. A Fine and Gray hazards model estimated the risk of transition into an institutional setting, with death before institutionalization considered a competing risk. RESULTS: In 2011, 4712 NHATS participants were living at home (78 +/- 8 y; 57% female; 80% white; 10% probable dementia; 7% with three or more activities of daily living disabilities). By 2017, 58% remained at home, 17% had either transitioned to an institution or died in an institution, and 25% died before institutionalization. In multivariable analyses that adjusted for age, sex, race, cognitive status, functional disability, multimorbidity, and Medicaid enrollment, participants were more likely to move out of the home into an institution if they had no social network (0 vs three or more people; subhazard ratio [sHR] = 1.8; 95% confidence interval [CI] = 1.2-2.5; P = .003) or lived alone (sHR = 1.9; 95% CI = 1.6-2.2; P < .0001). Older adults who enjoyed going to the movies, dinner, or the casino and visiting family or friends had a lower probability of institutionalization compared with participants who did not enjoy these activities or did not visit family or friends (adjusted sHR = .7; 95% CI = .6-.9; adjusted sHR = .7; 95% CI = .6-.9, respectively). CONCLUSION: Policy initiatives should target older adults with limited social support to reduce the risk of moving from home into an institution.

Stopping Eating and Drinking by Advance Directives (SED by AD) in Assisted Living and Nursing Homes.
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J. L. Wright, P. M. Jaggard, T. Holahan and Ethics Subcommittee of AMDA-The Society for Post-Acute and Long-Term Care.
J Am Med Dir Assoc 2019 Oct 3
The Ethics Subcommittee of AMDA-The Society for Post-Acute and Long-Term Care Medicine (“The Society”) presents arguments for and against Stopping Eating and Drinking by Advance Directives (SED by AD). SED by AD is a type of advance directive in which a proxy is instructed to stop offering food and fluids to a person when they reach a certain stage of dementia. Although most conversations regarding SED by AD focus on patient autonomy and the right to determine one’s care, we propose that the ethical principle of justice-the obligation to treat all individuals equally regardless of race, gender, and physical or cognitive ability-is the decisive principle in this controversy. We also suggest that implementing SED by AD can violate a physician’s obligation to beneficence and nonmaleficence. On the other hand, we identify with the families of our patients who see the refusal to follow an advance directive as an injustice of the highest order. In the end, The Society is convinced that no choice can be made here without practicing an injustice: if one refuses to implement SED by AD, one violates the autonomy of the person who drew up the advance directive. If, on the other hand, one refuses food and fluid to a resident who still accepts food, one risks practicing an injustice against that person as they are now. Recognizing that we have the greatest responsibility to our patients as they present to us in the residential setting, The Society recommends against implementing SED by AD in residents who still accept food and fluids, implementing instead, a policy of comfort feeding for those with advanced dementia.

Comparative Efficacy of Interventions for Aggressive and Agitated Behaviors in Dementia: A Systematic Review and Network Meta-analysis.
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J. A. Watt, Z. Goodarzi, A. A. Veroniki, et al.
Ann Intern Med 2019 Oct 15
Both pharmacologic and nonpharmacologic interventions are used to treat neuropsychiatric symptoms in persons with dementia. Purpose: To summarize the comparative efficacy of pharmacologic and nonpharmacologic interventions for treating aggression and agitation in adults with dementia. Data Sources: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO between inception and 28 May 2019 without language restrictions; gray literature; and reference lists scanned from selected studies and systematic reviews. Study Selection: Randomized controlled trials comparing interventions for treating aggression and agitation in adults with dementia. Data Extraction: Pairs of reviewers independently screened studies, abstracted data, and appraised risk of bias. Data Synthesis: After screening of 19 684 citations, 163 studies (23 143 patients) were included in network meta-analyses. Analysis of interventions targeting aggression and agitation (148 studies [21 686 patients]) showed that multidisciplinary care (standardized mean difference [SMD], -0.5 [95% credible interval {CrI}, -0.99 to -0.01]), massage and touch therapy (SMD, -0.75 [CrI, -1.12 to -0.38]), and music combined with massage and touch therapy (SMD, -0.91 [CrI, -1.75 to -0.07]) were clinically more efficacious than usual care. Recreation therapy (SMD, -0.29 [CrI, -0.57 to -0.01]) was statistically but not clinically more efficacious than usual care. Limitations: Forty-six percent of studies were at high risk of bias because of missing outcome data. Harms and costs of therapies were not evaluated. Conclusion: Nonpharmacologic interventions seemed to be more efficacious than pharmacologic interventions for reducing aggression and agitation in adults with dementia. Primary Funding Source: Alberta Health Services Critical Care Strategic Clinical Network. (PROSPERO: CRD42017050130).


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Events & Training Opportunities

Webinar Cannabis and dementia: Weeding out the evidence

Wednesday 6 November 10:00-11:00 MT
Presenter: Krista L. Lanctôt
There is increasing interest in the use of cannabinoids as a therapeutic intervention in dementia, particularly for agitation.

By the end of this presentation learners will be aware that:
-agitation is a common and persistent symptom in those with Alzheimer’s disease
-current pharmacotherapies have modest efficacy and/or poor safety
-there is a pharmacologic rationale for use of cannabinoids
-limited literature has evaluated the efficacy of THC and related compounds for agitation
-a pilot study of a cannabinoid for agitation has recently been completed

Online Certificate In Implementation Science, University Of California San Francisco

Cost US$2,500/course
The Online Certificate in Implementation Science program is a part-time program focused on theories and methods relevant to the design of strategies to facilitate uptake of health-related interventions. Scholars can choose to take individual courses or complete four required and two electives courses to obtain the certificate. The courses and certificate program are designed for people from a broad range of professional settings who are currently engaged in the development, implementation and evaluation of strategies to promote and improve health and health care quality, including clinical and public health researchers, quality improvement officers, community-based clinic staff, public health and public policy practitioners, and clinicians. We welcome trainees who work in clinical and public health settings outside the U.S. UCSF students who sign up for the online certificate program will have the option of participating in in-person small-group sessions.

Gendered Innovations in Medicine, AI, and the Environment

Wednesday 23 October 12:00-13:30 SAB 3-21
Presenter: Londa Schiebinger
How can we harness the creative power of gender analysis for discovery and innovation?

In this talk Dr. Schiebinger identifies three strategic approaches to gender in research, policy, and practice:
“Fix the Numbers of Women” focuses on increasing women’s participation;
“Fix the Institutions” promotes gender equality in careers through structural change in research organizations; and
“Fix the Knowledge” or “Gendered Innovations” stimulates excellence in science and technology by integrating sex and gender analysis into research.

This talk focuses on the third approach. Dr. Schiebinger will discuss several case studies, including health & medicine, gender and fairness in machine learning, gender and the environment. To match the global reach of science and technology, Gendered Innovations was developed through a collaboration of over a hundred experts from across the United States, Europe, Canada, and Asia. They are now moving into South America and South Africa. Major funders for Gendered Innovations include the European Commission, the U.S. National Science Foundation, and Stanford University.

Gendered Innovations Workshop: How Integrating Sex and Gender Analysis into Research Enhances Excellence and Discovery

Wednesday 23 October 15:00-16:30 Telus 134
Presenter: Londa Schiebinger
In this workshop directed at faculty, postdocs, and advanced graduate students Dr. Schiebinger will discuss state-of-the-art methods of sex and gender analysis developed by the Gendered Innovations project. She will apply these methods to specific case studies, to policy for granting agencies, and to university curriculum development in STEMM fields.

Crossing the Finish Line of Grant Submission: R’s from the perspectives of the PI’s

Wednesday 30 October 13:00-14:00 MT
Presenter: David Chambers, Megha Ramaswamy, Rebekka Lee, Ted Skolarus
Dr. David Chambers will be joined by Drs. Lee, Ramaswamy, and Skolarus, all of whom have shared their work with our research community within the DCCPS Sample Grant repository. Their contributions cover a wide swath of research, representing R01s, R21s, dissemination, implementation, and deimplementation, and they will speak to their grantee experience and challenges and insights about the process

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Talking Quality: Reporting to Consumers on Health Care Quality

The Agency for Healthcare Research and Quality has updated its guide to best practices in public reporting on health care quality. The TalkingQuality website offers expert advice and research findings that cover the entire process of producing a report for health care consumers with comparative information on the quality of care.

NIHR:What makes an excellent doctoral/fellowship application?

To coincide with the launch of our Doctoral and Advanced Fellowships, we asked Gary Frost, Chair of the NIHR Doctoral Fellowship selection committee, to write about what he thinks makes an excellent application.

What makes an application excellent? Or to look at it in another way, given the diversity of the NIHR Academy portfolio (the number of professions applying for a diverse range of fellowships), is it possible to define an excellent application?

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Making time to talk: the challenge of spreading knowledge

How to revise and resubmit without despair

Research culture in biomedical science needs to change

Communicating science online increases interest, engagement and access to funds

The SPOR Canadian Data Platform: opportunity for
multi-provincial research

Study documents the social isolation of older U.S. adults

Caregiver Distress is on the Rise. New Report Shares Wishlist of What Caregivers Say They Need

New tool helps seniors and their health-care team reduce overmedication, Canadian study finds

Nursing home residents with advanced dementia often experience ‘burdensome interventions’ in final days of life: study

U.S. surgeons general: Dementia is our top public health crisis

From dementia to medically assisted death: A Canadian woman’s journey, and the dilemma of the doctors who helped

Drugs shouldn’t be the first option to ease agitation from dementia: study

How the elderly and frail are caught in the crosshairs of push to end hallway medicine

How to improve healthcare improvement-an essay by Mary Dixon-Woods

Neglecting Major Health Problems and Broadcasting Minor, Uncertain Issues in Lifestyle Science

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Postdoctoral Position In Clinical Quality Improvement

Pediatrics, University of Alberta, Edmonton
DEADLINE: 25 November
The fellowship will occur within a large-scale mental health initiative in Alberta’s pediatric emergency departments in Edmonton and Calgary. The initiative entails clinical collaboration between administrative, clinical and quality leadership at the Stollery Children’s Hospital (Edmonton, Alberta) and Alberta Children’s Hospital (Calgary, Alberta), and research collaboration between the Departments of Pediatrics at the University of Alberta and University of Calgary. The postdoctoral fellow will work alongside clinical and research leadership to develop, implement and evaluate Edmonton-based quality improvement activities transform pediatric mental health care in the pediatric emergency department at the Stollery Children’s Hospital. The fellow will participate in both interdisciplinary research and clinical operations (hospital) committee work to gain understanding of the context in which improvement work is taking place and how to best effect change in the complex area of mental health care delivery. The position will involve developing expertise in using statistical process control for the evaluation of health care delivery changes, and overseeing the analysis of quality improvement data using run charts, statistical process control, and traditional statistical methods. The fellow will also have opportunities to enhance academic writing and communication skills and establish new professional and peer collaborations.

CIHR Scientific Project Coordinator

University of Western Ontario, London, ON
The Scientific Project Coordinator researches and prepares background and reference materials for the various needs of the Institute and acts as the primary point of contact for the Institute on working groups and committees. The incumbent manages relationships and follow-up activities with partners in collaboration with the other members of the IA team. The incumbent will also contribute to the development and drafting of articles and funding opportunities on relevant topics and will be the scientific resource for the Institute on the projects and initiatives that they lead.

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